麻醉期间肺保护性通气可减少肺癌患者术后并发症：双盲、随机、对照试验
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Protective ventilation during anaesthesia reduces major postoperative complications after lung cancer surgery：A double-blind randomised controlled trial
背景与目的
胸外科肺切除术与术后肺部并发症高发生率有关。研究表明高潮气量控制通气是腹部手术术后呼吸系统并发症的危险因素，且使用低潮气量和呼气末正压（PEEP）通气具有保护作用。本研究主要探讨低潮气量和PEEP通气对胸部手术后主要并发症的影响。
方 法
本研究为前瞻性、双盲、随机对照试验，共纳入346名接受肺叶切除术或全肺切除术的肺癌患者，麻醉期间将手术患者随机分为两组：低潮气量和PEEP组（LPV组）：控制潮气量5ml/kg及PEEP 5～8 cmH2O；对照组（C组）：潮气量10ml/kg且无PEEP。主要结果为术后30天内主要并发症发生情况：肺炎、急性肺损伤、急性呼吸窘迫综合征、肺栓塞、休克、心肌梗死或死亡等。
结 果
LPV组23名患者发生严重的术后并发症（13.4％，23/172），对照组为38名（22.2％,38/171），（OR=0.54,95％CI：0.31～0.95，P = 0.03）。与C组比较，LPV组患者其他并发症（室上性心律失常、支气管阻塞、肺不张、高碳酸血症、支气管瘘和持续漏气）的发生率较低（37.2vs49.4％，OR=0.60,95％CI：0.39～0.92，P = 0.02）。与C组比较，LPV组患者住院时间较短（11/12天，IR：9～15天/9～16天，P=0.048）。
结 论
与高潮气量控制通气相比，麻醉期间低潮气量联合PEEP控制通气可减少肺癌患者术后并发症的发生情况并改善预后。
原始文献摘要
Emmanuel Marret, Raphael Cinotti, Laurence Berard,etc; Protective ventilation during anaesthesia reduces major postoperative complications after lung cancer surgery：A double-blind randomised controlled trial；Eur J Anaesthesiol 2018; 35:1–9.
BACKGROUND： Thoracic surgery for lung resection is associated with a high incidence of postoperative pulmonary complications. Controlled ventilation with a large tidal volume has been documented to be a risk factor for postoperative respiratory complications after major abdominal surgery, whereas the use of low tidal volumes and positive end-expiratory pressure (PEEP) has a protective effect.
OBJECTIVE： To evaluate the effects of ventilation with low tidal volume and PEEP on major complications after thoracic surgery.
DESIGN： A prospective, double-blind, randomised controlled study.
SETTING： A multicentre trial from December 2008 to October 2011.
PATIENTS ：A total of 346 patients undergoing lobectomy or pneumonectomy for lung cancer.
MAIN OUTCOME MEASURES ：The primary outcome was the occurrence of major postoperative complications (pneumonia, acute lung injury, acute respiratory distress syndrome, pulmonary embolism, shock, myocardial infarction or death) within 30 days after surgery.
INTERVENTIONS： Patients were randomly assigned to receive either lung-protective ventilation (LPV group) [tidal volume 5 ml /kg ideal body weight + PEEP between 5 and 8 cmH2O] or nonprotective ventilation (control group) (tidal volume 10 ml/ kg ideal body weight without PEEP) during anaesthesia.
RESULTS ：The trial was stopped prematurely because of an insufficient inclusion rate. Major postoperative complications occurred in 23/172 patients in the LPV group (13.4%) vs. 38/171 (22.2%) in the control group (odds ratio 0.54, 95% confidence interval, 0.31 to 0.95, P = 0.03). The incidence of other complications (supraventricular cardiac arrhythmia, bronchial obstruction, pulmonary atelectasis, hypercapnia, bronchial fistula and persistent air leak) was also lower in the LPV group (37.2 vs. 49.4%, odds ratio 0.60, 95% confidence interval, 0.39 to 0.92, P = 0.02).The duration of hospital stay was shorter in the LPV group, 11 [interquartile range, 9 to 15] days vs. 12 [9 to 16] days, P = 0.048.
CONCLUSION： Compared with high tidal volume and no PEEP, LPV combining low tidal volume and PEEP during anaesthesia for lung cancer surgery seems to improve postoperative outcomes.
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